The True Cause of Sleep Disturbances During Perimenopause

Between 40% and 60% of women in perimenopause and menopause face insomnia or other sleep challenges, yet these issues are often brushed aside as just a natural part of aging. Thanks to initiatives like the short film The M Factor, featuring Naomi Watts and Halle Berry, awareness of these midlife sleep struggles is finally gaining traction. Here’s what’s really behind the issue and what can help.

Why Does Perimenopause Cause Insomnia?

Perimenopause affects sleep due to three overlapping hormonal changes. Both estrogen and progesterone decrease, melatonin production declines with age, and cortisol, the body’s primary stress hormone, often increases.

Higher estrogen and progesterone levels foster deeper sleep and decrease nightly awakenings, while their reduction can directly and indirectly disrupt sleep. Lowered estrogen can also lead to night sweats, further interrupting sleep. Additionally, cortisol may be elevated during this transition, complicating both falling asleep and staying asleep. Approximately 40% to 60% of women during this phase experience these issues, yet many receive no treatment as they are often dismissed as typical aging symptoms.

Why Is Perimenopause Insomnia Getting More Attention Now?

Interest in menopause-related topics has steadily increased since 2005, with a surge of celebrity advocacy bringing midlife health into broader discussions.

A peer-reviewed analysis of Google search data indicates two decades of unaddressed informational demands. Following the viewing of The M Factor, 80% of female viewers reported a better understanding of menopause, 75% felt more inclined to consult a physician, and 85% felt empowered to discuss it with family and friends. This cultural shift is facilitating women’s ability to seek help for symptoms like insomnia that they may have previously endured in silence.

What Actually Helps Insomnia During Perimenopause?

The most effective approach combines improved sleep hygiene with Cognitive Behavioural Therapy for Insomnia (CBT-I), which is recognized as a primary treatment for chronic insomnia.

Sleep hygiene lays the groundwork:

• Maintain a consistent bedtime and wake time, even on weekends.
• Set the bedroom temperature to between 65 and 68 degrees Fahrenheit.
• Opt for breathable bedding and moisture-wicking sleepwear.
• Limit alcohol, which exacerbates night sweats and interrupts REM sleep.
• Avoid caffeine after early afternoon.
• Reduce screen time 60 to 90 minutes prior to bedtime.

CBT-I addresses the racing thoughts and anxiety that often heighten during hormonal fluctuations.

“We are designed so that if a lion, tiger, or bear approaches, our response to that threat is stronger than our capacity to fall back asleep. While we need this hyperarousal response for survival, I teach my patients behavioral tools like CBT-I to help them return to sleep,” explained Natalie Solomon, PsyD, a clinical psychologist at the Stanford Sleep Health and Insomnia Program.

Which Supplements Help Perimenopausal Sleep Problems?

Low-dose melatonin, magnesium glycinate, and black cohosh show the most backing, but it’s essential to consult a healthcare professional before using supplements.

Melatonin in doses of 0.5 to 3 mg may assist with sleep onset difficulties. Magnesium glycinate aids muscle relaxation and relieves tension. Black cohosh has variable evidence in alleviating hot flashes for some women. However, just because something is natural doesn’t mean it’s devoid of risks. Supplements may interact with prescription medications, so it’s important to consult a doctor, especially if you have existing medical conditions.

When Should You See a Doctor About Midlife Insomnia?

Not every instance of midlife sleep loss is hormone-related. Consult a physician if you recognize symptoms that suggest an issue beyond perimenopause-related insomnia.

Warning signs to discuss with a physician include:

• Loud snoring or gasping for breath during sleep.
• Severe daytime drowsiness.
• Consistent low mood.
• Rapid heart rate.
• Unexplained weight fluctuations.

Conditions like sleep apnea, restless leg syndrome, thyroid disorders, and depression become more prevalent during perimenopause and require different treatments than hormone-related insomnia. A sleep study or blood tests may be necessary.

“It’s common for perimenopausal and menopausal women to experience both sleep apnea and insomnia, and it’s crucial to understand that they are distinct disorders that necessitate different approaches. If you’re frequently struggling to fall or stay asleep, you may be dealing with insomnia and could benefit from CBT-I. Conversely, if your difficulties revolve around brief awakenings, snoring, or non-refreshing sleep, it may be wise to consult your doctor about a sleep study to check for sleep apnea,” Dr. Solomon advised.